Healthcare Provider Details

I. General information

NPI: 1972950095
Provider Name (Legal Business Name): CINDY SHANKLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MARGO AVE
BARDWELL KY
42023-9005
US

IV. Provider business mailing address

608 COUNTY FARM RD
WICKLIFFE KY
42087-9204
US

V. Phone/Fax

Practice location:
  • Phone: 270-628-5424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: